Comparing meta-analysis and ecological-longitudinal analysis in time-series studies: a case study of the effects of air pollution on mortality in three Spanish cities

The objective of this paper is to introduce a diVerent approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. Design—The approach is illustrated by providing quantitative estimates of the short-termeVects of air pollution on mortality in three Spanish cities, Barcelona,Valencia and Vigo, for the period 1992–1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were nonlinear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. Main results—The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 μg/m3 and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 μg/m3 of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant,especially those among air pollutants and meteorological variables. Conclusions—Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities

Prediction of postprandial blood glucose under intra-patient variability and uncertainty and its use in the design of insulin dosing strategies for type 1 diabetic patients

In this thesis I propose a novel method to estimate the dose and injection-to-meal time for low-risk intensive insulin therapy. This dosage-aid system uses an optimization algorithm to determine the insulin dose and injection-to-meal time that minimizes the risk of postprandial hyper- and hypoglycaemia in type 1 diabetic patients. To this end, the algorithm applies a methodology that quantifies the risk of experiencing different grades of hypo- or hyperglycaemia in the postprandial state induced by insulin therapy according to an individual patient’s parameters. This methodology is based on modal interval analysis (MIA). Applying MIA, the postprandial glucose level is predicted with consideration of intra-patient variability and other sources of uncertainty. A worst-case approach is then used to calculate the risk index. In this way, a safer prediction of possible hyper- and hypoglycaemic episodes induced by the insulin therapy tested can be calculated in terms of these uncertainties.

Ecological analysis of periphytic diatoms in Mediterranean coastal wetlands (Empordà wetlands, NE Spain)

S'han estudiat els efectes dels factors ambientals sobre el perífiton dels sistemes lenític fluctuants del aiguamolls de l'Empordà. L'estudi s'ha realitzat als tres nivells d'integració: nivell d'ecosistema considerant el rol del perífiton envers els altres productors primaris; a nivell de comunitat, estudiant la composició específica de les diatomees i a nivell de població estudiant la plasticitat fenotípica d'una espècie de diatomea (Nitzschia frustulum). A nivell d'ecosistema s'observa que els factors que afavoreixen el predomini dels diferents tipus de productors primaris (perífiton, fitoplàncton i macròfits) són la renovació i el grau d'eutròfia de l'aigua. A nivell de comunitat els factors determinants en la composició i distribució de les espècies de diatomees són els gradients confinament-inundació així com la productivitat del sistema. En funció d'aquest factors s'han establert 5 associacions de diatomees. A nivell de població es demostra que tant la salinitat, com la relació N : P a l'aigua com el moviment de l'aigua afecten la morfologia i ultraestructura de la valva de N. frustulum. De forma interessant s'observa que la salinitat, considerada com a factor individual, afecta N. frustulum a nivell poblacional provocant-li modificacions en la morfologia de la valva, per en canvi, no afecta a nivell de comunitat, ja que totes les espècies de diatomees presents en ambients de salinitat fluctuant són eurihalines.